可能切除胰腺癌治疗的现状与争议

Current status and controversies in the management of borderline resectable pancreatic cancer

可能切除胰腺癌是目前胰腺外科领域极具争议的热点问题。争议焦点主要集中于该病定义和治疗方法。本文汇集国内胰腺外科领域5位著名专家及其团队，结合各自中心临床经验．从不同角度探讨可能切除胰腺癌定义和治疗的现状与争议。其中郝纯毅教授回顾并剖析可能切除胰腺癌概念的缘起和局限及治疗模式的探索．认为高水平胰腺疾病中心和多学科协作诊断与治疗模式是可能切除胰腺癌患者治疗的最佳选择。刘续宝教授认为多数可能切除胰腺癌可手术切除，应依据肿瘤是否侵犯邻近血管及侵犯程度决定直接手术还是先行新辅助治疗。孙备教授提出6方面原因，认为对可能切除胰腺癌的治疗，直接手术可能是更符合实际、更可行的选择。梁廷波教授和白雪莉教授则认为对可能切除胰腺癌应先行新辅助治疗，因新辅助治疗可消灭隐匿微小转移灶、降低肿瘤负荷，新辅助治疗后手术患者R0切除率高、淋巴结转移率低，可提高治愈率，带来生存获益。

The borderline resectable pancreatic cancer is high a controversial hotspot in the field of pancreatic surgery, and the controversy mainly focuses on definition and treatment. Five famous experts and their teams in pancreatic surgery dis- cussed present situation and dilemmas in treatment of borderline resectable pancreatic cancer based on clinical experiences. Professor Hao Chunyi has reviewed and analyzed origin of the definition and treatment model of borderline resectable pancreatic cancer, and proposed that high-level pancreatic disease center and multidisciplinary collaboration diagnosis and treatment may be the best choice for resectable pancreatic cancer. Professor Liu Xubao suggested surgical treatment for most of borderline resectable pancreatic cancer, and whether or not tumor invades adjacent blood vessels and invasion level will be used to decide direct surgery or neoadjuvant therapy. Professor Sun Bei proposed 6 causes, and direct surgery may be more realistic and feasible option for borderline resectable pancreatic cancer. Professors Liang Tingbo and Bal Xueli recommended that neo- adjuvant therapy should be performed due to defeat hiding micro- metastasis lesions and reduce tumor burden, and there was a higher R0 resection rate and lower lymph node metastasis rate after neoadjuvant therapy, meanwhile, it can also increase cure rate and is benefited to survival.